Notes MOA Use ADE Contra-indication

Pharmaco-kinetic

Haematinics- are the drugs used for the prevention and Rx of anemia,by +sing the synthesis of blood. It occur due to (1) blood loss,(2) impaired blood cell formation-due to def of iron,folic acid and vitamin b12 (3)Bone marrow depression (4)+se destruction of RBC.

Normal Hb level- 13-14gms/100mlIron content in adult 3.5gm, among this 66% present in Hb.

Cyanocobalamin- Perinicious anaemia-Haemolytic anaemia-Vit b12 deff-HaemorrhageRenal or hepatitidesDose: 100- 500µgFolic acid-Megaloblastic anaemia-Macrocytic anaemia-Liver disease-AlcoholismDose: 0.8 mg

Classification Pyridoxine Folinic acidCyanocobalamin (vit B12) Riboflavin CopperMethycobalamin Iron cobaltFolic acid Erythropoietin

Erythropoitein(E)- producd 1° ly by peritubular cells in the proximal tubule of kidney. In anaemia renal secretion of erythropoietin increases rapidly manifold. E levels are always detectable in plasma .given by parentral route

Binding to receptors on the surface of erythroid precursor cells ->+se in intracellular concen of Ca and arachidonate and changes in intracellular phosphorylatn.Stimulates prilferatn,maturatn,&Hb formn by committed erythroid progenitors

-Rx of anemia of chronic renal failure.-Anemia in AIDS patient treating with Zidovudine-Anaemia assoc with cancer therapyDoasage: (A)- 25-50 i.u /kg body wt i.v over 1-2 min 3 times /weekWeekly dose 100-300 i.u/ kg in 2-3 inj.

Hypertension&Seizures in renal disease patient.

Hypersensitivity to drugMammalian cell products &human serum albumin

Iron III hydroxide Polymaltose Complex(IPC)

VITCOFOL 150ml syrup,drops, tab, caps

Absorption of ferric iron from IPCcontrolld by a fd back mechsm.IPC binds at mucosal surface>

Rx of latent iron deficiency anaemia.-Prevention of iron and folic acid deff,

Low incidence of ade-Pressure in epigastric reason-Nausea

release reqd amount of ferric iron actively transport to mucosal cell by carrier protein> releasedfor binding to ferritin & transferrin

bef,during and after pregnancy.

-constipation or diarrohea can occur

Cardiotonics- sub which +se the myocardiac contaractility and output in hypodynamic heart without a proportionate +se in O2 consumptn.Thus efficiency of failing heart +sed.Classification1)Cardiac glycosides- sorce(digitalis purparea, D. lanata)DigitoxinGitoxinGitalinStrophanthin-k(strophanthus.kombe)Strophanthin –G(S. grates)2)synthetic positive ionotropicdrugs (Amrinone, Milrinone)

decreases the action of the Na+/K+ ATPase channel by binding to an allosteric site> +se in Ca2+ concentration> +se force of contraction>+se cardiac output> normal heart rate(+ve ionotropic action-influence contctlty of cardiac muscle tissue & -ve chronotropic effeinfluence rate of cardiac rhythm.)

-Congestive Cardiac failure-Paroxysmal supraventricular tachycardia

Dose:0.25-1.5 mg daily

AnorexiaNauseaVomitingDiarrhoeaAbd.painFatigueDrowsinessHeadacheDisorientationConfusionBlured visionGynacomastiaYellow visionPhotophobiaVenricular abnormal cardiac rythm

-ventricular tachycardia-Hypertrophic obstructive cardio myopathy,HyperkalemiaHypercalcemia

Given orally, abs is prominent with tabs of diif brands. Distributed to most body tissuesandhigh concen in cardiac tissue. Excreted primarily by kidneyOnset of action PO:1/2- 2hrs , iv 5-30 minsDIXIN 0.2mg tab, 0.5mg inj, 1.5mg /30 ml syrup

AmrinoneBypiridine deri & phosphodiestrase III inhib (PDE-III)

Selective inhibitor of CGMP,cAMP.PDE III causes vasodilation with a consequent systemic vascular resistance.+ses both the force of contraction and velocity of relaxation cardiac muscle.

-short term management of CCF in patients unresponsive to digitalis, diuretics or vasodilators

NauseaAbdm.painDiarrhoeaThrombocytopenia(reversible)Fever Hepatotoxicity

Hypersensitivity-Children-Acute phase of myocardial infarction

IV act quicklyAfter oral peak effect noticed in 1-3 hrsDuration ½- 2hrs

Anti anginal drugs

Used to prevent attack of angina pectoris. Results from anorexia or cardiac muscle. Pain syndrome due to induction of an adverse O2 supply /demand situation in apotion of myocardium.pain in chest , radiatesdown to shoulder and arms.

2 principal forms

1.Classicalor stable angina- predictably provoked by exercise, emotions, eating.pathology-svere artherosclerotic affliction of large coronary arteries conduacting vessels.

2. variant or prinzmetals angina

-occurs at rest or sleep and unpredictable

Glyceryl trinitrate